Istituto Fiorentino di Cura e Assistenza (IFCA), via del Pergolino 4/6, Florence, 50139, Italy.
Department of Public Health, School of Medicine, Federico II University, Via S. Pansini, Naples, 80131, Italy.
Arch Orthop Trauma Surg. 2024 Nov;144(11):4677-4684. doi: 10.1007/s00402-024-05300-x. Epub 2024 Apr 3.
Upper-tight tourniquet is widely used in Total Knee Arthroplasty in different modalities. However, it has been associated with a negative impact on post-operative muscle strength end pain. This study aimed to investigate the effect of tourniquet on post-operative pain and recovery in enhanced recovery joint surgery.
In this prospective randomized study, we included 116 patients undergoing to TKA. Surgery was performed with a staged use of tourniquet in Group A (58 patients) and without tourniquet in Group B. In the former group a low-pressure tourniquet was deflated after bone cuts to allow hemostasis of posterior recess and re-inflated for cementation. For all patients a multimodal fast-track recovery protocol was used. Time to reach rehabilitation milestones was recorded as primary endpoint. Range of motion, pain, hemarthrosis, total blood loss, surgical field visualization, Knee Score (KS) and Oxford Knee Score (OKS) were considered as secondary outcomes.
. No statistically significant differences were found (group B: average 1.3 ± 0.6 day; group A: average 1.2 ± 0.5 day). Group A had a shorter mean surgical time and a clearer surgical field visualization. Group B had a larger estimated blood loss and hemoglobin drop without a statistically significant difference in the transfusion rate. No differences between the groups were seen in the KS, OKS and range of motion (ROM) and post-operative joint swelling. Pain score was similar between cohorts and recorded thigh pain was surprisingly greater in group B.
The use of tourniquet in TKA surgery helps to minimize intraoperative blood loss and improves surgical field visualization. Its application with a modern and staged protocol does not affect the functional outcomes (OKS, KSS, ROM) of the early post operative period without compromising the fast-track recovery.
在全膝关节置换术中，上止血带被广泛应用于不同方式。然而，它与术后肌力下降和疼痛有关。本研究旨在探讨止血带对加速康复关节置换术术后疼痛和恢复的影响。
在这项前瞻性随机研究中，我们纳入了 116 例行 TKA 的患者。手术时，A 组（58 例）采用分阶段使用止血带，B 组（58 例）不使用止血带。在前一组中，在进行骨切开后，放低压力止血带以允许后隐窝止血，然后再充气用于骨水泥固定。所有患者均采用多模式快速康复方案。达到康复里程碑的时间是主要终点。记录关节活动度、疼痛、关节积血、总失血量、手术视野、膝关节评分（KS）和牛津膝关节评分（OKS）作为次要结果。
两组患者在达到康复里程碑方面无统计学差异（B 组：平均 1.3±0.6 天；A 组：平均 1.2±0.5 天）。A 组的平均手术时间较短，手术视野更清晰。B 组的估计失血量较大，血红蛋白下降，但输血率无统计学差异。两组在 KS、OKS 和关节活动度（ROM）以及术后关节肿胀方面无差异。疼痛评分在两组间相似，记录的大腿疼痛在 B 组中出人意料地更大。
在 TKA 手术中使用止血带有助于减少术中失血量，并改善手术视野。采用现代、分阶段的方案应用止血带不会影响术后早期的功能结果（OKS、KSS、ROM），也不会影响快速康复。
